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The initial symptoms are followed by a stage called asymptomatic HIV clinical latency, or long-term HIV. 1 Without treatment, this second period of the natural history of HIV disease can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are few or no symptoms initially, close to the end of this phase lots of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months. Std Test near Harbor Point, Michigan. Harbor Point MI Std Test. 2

Although most HIV-1 infected individuals have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a little proportion (about 5%) retain elevated amounts of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV accountants or long term nonprogressors (LTNP). 31 Another group consists of those who keep a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "elite suppressors". They represent around 1 in 300 contaminated persons. Harbor Point Michigan Std Test. 32

Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4 T cell count below 200 cells per L or the incidence of specific diseases in association with an HIV disease. Std Test nearest Harbor Point Michigan United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alert to the existence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

People with AIDS have a higher danger of developing various viral-induced cancers, including Kaposi's sarcoma , Burkitt's lymphoma , primary central nervous system lymphoma , and cervical cancer 27 Kaposi's sarcoma is the most frequent cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of nearly 16% of individuals with AIDS and is the first sign of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more often in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and also the white portion of the eye) is also more common in those with HIV. 36

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The most frequent mode of transmission of HIV is through sexual contact with an infected individual. 11 The bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 however, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this particular public accounting for 67% of new cases and 83% of new cases among males over 12 years old. While 28 percent of transgender women test positive 49 About 15% of bisexual and homosexual men have HIV. 49 50 Std Test nearest Harbor Point.

With respect to unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high income nations. 51 In low income nations, the risk of female-to-male transmission is estimated as 0.38% per action, and of male-to-female transmission as 0.30% per action; the equivalent approximations for high income nations are 0.04% per act for female to male transmission, and 0.08% per act for male to female transmission. 51 The danger of transmission from anal intercourse is particularly high, estimated as 1.4-1.7% per act in both heterosexual and gay contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it is still present. 53 The danger from receiving oral sex was described as "almost nil"; 54 however, a couple instances are reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral intercourse. 56 In settings involving prostitution in low income countries, risk of female-to-male transmission was estimated as 2.4% per action and male-to-female transmission as 0.05% per action. 51

The next most frequent way of HIV transmission is via blood and blood products. 11 Blood-borne transmission can be through needle-sharing needle stick injury, during intravenous drug use, transfusion of contaminated blood or blood product, or medical shots with unsterilized equipment. The threat from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test closest to MI, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per action and the hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in some regions more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed countries the danger of getting HIV from a blood transfusion is very low (less than one in half a million) where improved donor selection and HIV screening is performed; 11 for example, in the UK the risk is reported at one in five million 65 and in the United States it was one in 1.5 million in 2008. 66 In low income countries, only half of transfusions may be suitably screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std test nearest MI, United States. 11 68 Although rare due to screening, it is possible to acquire HIV from tissue and organ transplantation 69

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HIV may be transmitted from mother to child during pregnancy, during delivery, or through breast milk causing infection in the infant. 73 74 This is the third most common way in which HIV is transmitted globally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in those who also breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Preventive treatment includes the mom administering antiretroviral drugs to the newborn, averting breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those who do breastfeed. Many of these measures are however not accessible the developing world. 75 If food is contaminated by blood during pre- it may introduce a risk of transmission. 71

HIV is a member of the genus Lentivirus , 79 part of the family Retroviridae 80 Lentiviruses share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically in charge of long-duration sicknesses with a very long incubation period 81 Lentiviruses are transmitted as single-stranded, positive- sense , enveloped RNA viruses Upon entrance into the target cell, the viral RNA genome is converted (turn transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported together with the viral genome in the virus particle. The resultant viral DNA is subsequently imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus might become latent, enabling its particular host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus could be transcribed, generating viral proteins that are packaged and discharged from the cell as new virus particles that begin the replication cycle anew and new RNA genomes. 84

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HIV is now understood to disperse between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it employs hybrid spreading mechanics. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter. 85 HIV may also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std Test in Harbor Point Michigan. 86 87 The hybrid distributing mechanisms of HIV lead to the continuing replication of the virus against antiretroviral therapies. 85 88

Following the virus enters the body there's a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood. During primary infection, the degree of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a noticeable fall in the amount of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell response is considered to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was associated with a better prognosis as well as slower disease progression, though it doesn't eliminate the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are crucial to the immune response and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the acute and chronic phases. 93 During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4 T cell depletion, although apoptosis might also be a variable. During the chronic stage, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decline in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for years after a person is infected, the majority of CD4 T cell loss occurs in the intestinal mucosa, which harbors most of the lymphocytes found within the body, especially during the very first weeks of infection. 95 The reason for the preferential loss of mucosal CD4 T cells is that nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to the cells, whereas merely a tiny fraction of CD4 T cells in the bloodstream do so. 96 A specific genetic change that alters the CCR5 protein when present in both chromosomes very effectively prevents HIV 1 infection. 97

HIV seeks out and destroys CCR5 expressing CD4 T cells during acute disease. The disease is eventually controlled by 98 A vigorous immune response and starts the latent phase. CD4 T cells in mucosal tissues remain especially changed. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the chronic stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and also the immune response to HIV replication that is ongoing. Additionally it is linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Harbor Point MI std test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all individuals 15years to 65years old including all pregnant women. 101 Furthermore, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many areas of the planet, a third of HIV carriers simply discover they are infected at an advanced phase of the disorder when AIDS or acute immunodeficiency has become obvious. Std Test closest to Harbor Point MI. 27

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Antibody evaluations in kids younger than 18months are normally incorrect due to the continued presence of maternal antibodies 102 Hence HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen. 24 Much of the world lacks access to dependable PCR testing and a lot of places simply wait the kid is old enough for antibody testing that is exact or until either symptoms develop. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the people were informed of their HIV status. Harbor Point Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were examined 103 which signified a substantial increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated disease for surveillance purposes: the WHO disease staging system for HIV infection and disease , 24 along with the CDC classification system for HIV infection 104 The CDC 's classification system is more often adopted in developed nations. Since the WHO 's staging system doesn't require laboratory tests, it's satisfied to the resource-restricted conditions encountered in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, both systems allow comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger of HIV transmission by approximately 80% over the long term. 106 When condoms are used by a couple in which one person is infected, the speed of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may offer an equivalent level of protection. Std test nearby Harbor Point. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its inclination to cause vaginal and rectal irritation. 110

Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". 111 Due to these studies the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007 in places with a high rates of HIV. 112 Yet, whether it protects against male-to-female transmission is contested, 113 114 and whether it's of advantage in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does recommend for all sexually active heterosexual males and that it be discussed with men who have sex with men as an alternative. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behaviour, hence negating its preventive effects. 119

Plans encouraging sexual abstinence don't seem to affect subsequent HIV danger. 120 Signs of any gain from peer instruction is equally inferior. 121 Comprehensive sexual education provided at school may decrease high risk behaviour. 122 A significant minority of young people proceeds to participate in high risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std Test near MI, United States. 123 Voluntary counselling and testing individuals for HIV doesn't influence dangerous behaviour in individuals who test negative but does increase condom use in those who test positive. 124 It isn't understood whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is an extremely productive way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test nearby Harbor Point Michigan, United States. 125 TASP is associated with a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir , with or without emtricitabine , is successful in a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It might also be successful in intravenous drug users with a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. 144 Initially therapy is commonly a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents including protease inhibitors (PI) are used if the above mentioned regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in folks of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it's recommended that it is continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have started. 27 The desired outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is successful are initially recommended after four weeks and once levels fall below 50copies/mL tests every three to six months are typically adequate. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of people during the first year. 27

Advantages of treatment contain a decreased risk of progression to AIDS and also a reduced danger of death. Std test in Harbor Point Michigan. Physical and mental health also improves. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a decreased risk of transmission to sexual partners of the disease and a drop in mom-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Motives for non-adherence include poor access to medical care, 149 inadequate social supports, mental illness and drug abuse 150 The complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 Even though price is an important problem with some drugs, 152 47% of people who desired them were taking them in middle and low income countries as of 2010 143 and also the rate of adherence is comparable in low-income and high-income countries. 153

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